Traumatic Events:

Center for Epidemiological Studies Depression Scale (CES-D)

The CES-D is a freely available and widely used 20 item self-report scale which measures the current level of depressive symptomatology in the general population, with an emphasis on depressed mood during the past week (Radloff 1977). The CES-D incorporates the main symtpoms of depression and was derived from five validated depression scales including the Beck Depression Inventory (BDI). It is freely available in the public domain, has been validated in community and primary care populations, in cardiac patients (Penninx et al. 2001) and older populations (Zich et al. 1990) and has good test-retest reliability (Ensel 1986).

Scores range from 0 to 60, with higher scores indicating more symptoms of depression. CESD scores of 16 to 26 are considered indicative of mild depression and scores of 27 or more indicative of major depression (Zich et al. 1990, Ensel 1986). Zich, Attkisson & Greenfield (1990) found the stringent cut-off score of 27 more useful for screening medical patients for depression than the standard cut-off score of 16. These classifications have been used in a number of studies by Ensel 1986; Zich, Attkisson et al. 1990; Logsdon, McBride et al. 1994; Geisser, Roth et al. 1997.

"The gold standard method for diagnosis of depression is the structured clinical interview based on DSM criteria. Two of he most commonly used screening tests are the Centre for Epidemiological Studies Depression Scale and Beck Depression Inventory.

Hospital Anxiety and Depression Scale (HADS)

The HADS (Zigmund and Snaith 1983) is a widely-used 14-item self-report scale designed to briefly measure current anxiety and depressive symptomatology in non-psychiatric hospital patients. It excludes somatic symptoms, therefore avoiding potential confounding by somatic symptoms (Snaith and Zigmond 1994). There are independent subscales for anxiety and depression. Scores on each scale can be interpreted in ranges: normal (0-7), mild (8-10), moderate (11-14) and severe (15-21). A score of 8 or above was considered to indicate depression for the IDACC project, consistent with other cardiac patient samples (Roberts, Bonnici et al. 2001; Strik, Honig et al. 2001; Strik, Honig et al. 2001). The HADS is considered to be valid measure of anxiety and depression in patients with myocardial infarction (Johnston, Pollard et al. 2000) and its high test-retest reliability make it suitable for monitoring these symptoms.

Snaith R (2003) regards a scores of 11 or higher to indicate probable 'caseness' of mood disorder on the anxiety or depression subscales, and a score of 8-10 being just suggestive of a disorder.

Beck Depression Inventory, version 2 (BDI)

The BDI (and subsequently, the BDI-II) is the most widely used instrument for measuring the severity of depression in psychiatric patients. It is recognised as a `gold standard' among self-report measures of depression. The BDI, originally developed in 1967, was updated in 1996 (BDI-II(Beck, Steer et al. 1996)) to correspond to the revised diagnostic criteria for depressive disorders as listed in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) (ref). It is a 21-item scale, with possible scores ranging from 0 to 63 (higher values correspond to higher depressive symptomatology). Beck et al. (1996) suggest that scores be interpreted in ranges: not depressed (0-13); mild depression (14-19); moderate depression (20-28); and severe depression (29-63).

The BDI was used in the IDACC project as an additional index of depression severity in patients identified as `depressed, rather than as a screening instrument for the total sample. A group of `non-depressed' participants was also given the BDI-II for comparison purposes. The cost of routinely using the BDI-II as a screening instrument was deemed prohibitive due to copyright.

Assessment of Quality of Life (AQoL)

The AQoL (Hawthorne, Richardson et al. 1999; Hawthorne, Richardson et al. 2000) was developed in Australia as a measure of five domains of health-related quality of life: illness, independent living, physical ability, psychological state and social interaction. It is a quick and easy-to-complete self-report scale directed at the respondent's evaluations of their health during the previous week Items are scored from 1-4 with higher scores indicative of worse health related quality of life. The AQoL has sophisticated theoretical and statistical foundation.

Short Form-36 Health Survey Questionnaire (SF-36)

The Short Form-36 Health Survey Questionnaire (SF-36) was developed for use as a survey of health status (Ware and Sherbourne 1992). Its 36 items measure eight domains of health: physical functioning; role limitations due to physical problems; social functioning; bodily pain; general mental health; role limitations due to emotional problems; and vitality. These scales are collapsed into 2 summary scales, the physical component scale (PCS) and mental health component scale (MCS). All scores are transformed 0-100, and the 2 summary scales each have a mean of 50 and standard deviation of +/-10. Lower scores equate to poorer health status, and 100 represents the best health state.

One additional question measures perception of health changes during the last year. The SF-36 is a generic multi-dimensional health status measure that has been widely used for many health conditions, enabling results of studies to be compared with other published data using the SF-36.

Scores range from 0 to 24 with high scores indicating greater optimism. Evidence suggests that optimism is associated with lesser amounts of distress during times of difficulty, and hence is beneficial for physical

and psychological well-being. This may be mediated by the manner of coping with stress. The overall score may be further analysed in terms of positively and negatively worded items representing optimism and pessimism. (Desharnais, Godin et al. 1990 and Scheier et al 1999 report studies of optimism on outcomes in cardiac patients.)

Multidimensional Scale of Perceived Social Support (PSSS)

The Multidimensional Scale of Perceived Social Support (PSSS) is a validated 12-item instrument designed to assess perceptions about support from family, friends and a significant other. The scale was

developed by Zimet et al. in 1988. The items are divided into factor groups relating to the source of support, with scores ranging from 1 to 7. High scores indicate high levels of perceived support. Social support is believed to contribute a moderating influence between stressful life events and depression.

Previous medical procedures - bypass surgery, angioplasty, pace-maker insertion, electrocardiogram, removal or part or whole of lung, lung transplant, or use of oxygen at home

Any other heart procedures

Any other respiratory procedures

Family history of heart disease

Family history of respiratory disease

Cigarette smoking habits (current and lifetime)

Height and weight

Number of weeks in the last 12 months when unable to carry out their normal duties because of the heart condition

Diagnosis in the last 12 months of anxiety, depression, stress-related problem or another mental health problem, and whether presently still have that condition

Whether currently receiving treatment for anxiety, depression, stress-related problems or any other mental health problem

Whether they have been troubled by feeling anxious, sad, angry, depressed, worried or "down in the dumps" for at least 2 weeks in the past 12 months

Who they have talked to about their feelings, mood or emotional health

Level of satisfaction with the way their emotional concerns were listened to

What makes it difficult to talk to their doctor about emotional concerns

Post Traumatic Stress Disorder (PTSD)

The Post Traumatic Stress Disorder (PTSD) module of the Composite International Diagnostic Interview (CIDI) was used. The CIDI (Andrews and Peters 1998), is a fully structured interview (also available in self-administered paper-and-pencil form) that maps symptoms onto DSM-IV and ICD-10 diagnostic criteria. The IDACC study utilised a subset of questions on traumatic events from the PTSD module of the CIDI.

PTSD Checklist - Civilian Version (PCL-C)

The PCL-C (Weathers 1993) is a brief, freely available 17-item screening instrument for assessing post-traumatic stress disorder (PTSD) in the general population.